Stroke Treatment in Burlington, VT

The best medicine for treatment of stroke is prevention. This involves making lifestyle changes to lower your cardiovascular risk factors. A stroke occurs when fatty deposits (plaque) build up inside the arteries leading to your brain and it is progressive, which means the plaque collects over time. But if you change your risk factors, you can maintain, and in some cases, reverse the effects of the disease.

Stroke treatment options at The University of Vermont Medical Center include:

Stroke Medications

The treatments, and therefore the medications, are different depending on whether you are having an ischemic stroke ( blocked artery, the most common kind of stroke ) or a hemorrhagic stroke ( bleeding into the brain).

Aspirin and clot-busting drugs (clinically called thrombolytics) are used to treat ischemic stroke . Aspirin works by thinning the blood to help prevent blood clots from forming. Tissue plasminogen activator (TPA) is a clot-busting drug that dissolves the blood clot to restore blood flow. TPA can be given through an injection into a vein in the arm or through a procedure called thrombolysis .

Hemorrhagic stroke drugs focus on lowering the pressure in your brain, lowering your blood pressure, or preventing seizures. Ischemic stroke drugs such as aspirin and TPA must be avoided for a hemorrhagic stroke since they can worsen bleeding.

Stroke Treatment Procedures

Sometimes a procedure may be necessary to treat your stroke . Some are minimally invasive and others are surgery. The UVM Medical Center surgeons are highly trained in treating strokes and their whole goal is to minimize the damage to your brain that a stroke can cause.

Thrombolysis

If you're having an ischemic stroke, your doctor may perform this minimally invasive procedure that dissolves abnormal blood clots and improves blood flow by inserting a long, thin tube (also called a catheter) through an artery in your groin and threading it to your brain. Then they release the TPA directly into the area where the stroke is happening.

Mechanical Clot Removal

This is a minimally invasive procedure where doctors use a catheter to operate a very small device into your brain to physically take hold of and get rid of the clot.

Carotid Endarterectomy

Carotid endarterectomy is surgery to remove plaque buildup in the carotid arteries. During a carotid endarterectomy :

A small incision is made in the neck just below the level of the jaw. The narrowed carotid artery is exposed.

The blood flow through the narrowed area may be temporarily rerouted (shunted). Rerouting is done by placing a tube in the vessel above and below the narrowing. Blood flows around the narrowed area during the surgery.

The artery is opened and the plaque is carefully removed, often in one piece.

A vein from the leg may be sewn (grafted) on the carotid artery to widen or repair the vessel.

This is a minimally invasive procedure where a catheter with a special balloon on the end is guided into an artery in the groin. The catheter is guided to the blocked area in the neck. Once in place, the balloon is inflated and deflated several times to widen the damaged artery. Once the artery is opened, the surgeon places a stent, a tiny wire mesh tube, in the artery to keep it open and allow blood to flow more freely.

Surgical Clipping

This surgery treats hemorrhagic stroke if you're at high risk for an aneurysm. It is an open surgical procedure that involves placing a metal clip at the base of the aneurysm, which cuts off its blood flow, causing it to deflate. Imaging experts identify the exact site of the aneurysm with cerebral angiography. The procedure involves opening the skull, locating the blood vessel that feeds the aneurysm and inserting the clip or clips.

Endovascular Surgery and Coiling

A less invasive procedure than open surgery, this method involves inserting a catheter into an artery in your groin and guiding it to the site of the aneurysm, using x-ray imaging. A thin wire is advanced into the aneurysm and forms a coil, disrupting blood flow and causing a clot.

Surgical Arteriovenous Malformation (AVM) Removal

Neurosurgeons may take out a smaller AVM if it's located in a reachable area of your brain, to remove the risk of rupture and lower the risk of hemorrhagic stroke. However, it's not always possible to remove an AVM depending on its size and location.

Post- Stroke Care

After a patient has stabilized, and is ready to begin the stroke recovery process, they begin secondary stroke prevention and rehabilitation .

Secondary Stroke Prevention and Education

One out of every five stroke survivors will have another stroke , known as secondary stroke, within five years of their initial stroke. Secondary strokes are often more dangerous and damaging because parts of the brain have already been injured and can be less resilient.

The UVM Medical Center offers prevention and education for patients, who are currently being treated for stroke to help prevent a recurrence, including:

Inpatient Rehabilitation

Inpatient Rehabilitation offers an intensive and specialized stroke recovery program. This service is located on two floors of The UVM Medical Center's Fanny Allen Campus in Colchester, with 35 beds designated for acute rehabilitation patients.

Here, our expert staff is focused on helping the patient regain his or her maximum level of independent function and return to independent community living. Comprehensive care is provided by a multidisciplinary team with specialized training in stroke rehabilitation and access to the most advanced equipment.

In addition to rehabilitation , patients receive stroke recovery follow-up care from neurologists with specialized training in stroke care and a stroke nurse practitioner who offer a weekly outpatient clinic for patients.

Medical Psychology

Psychological care is a critical component of helping stroke patients return to functioning. Stroke patients often face depression and frustration, as well as psychological issues such as memory and language impairment which can lead to impaired judgment and awareness, and behavioral issues.

Licensed clinical psychologists, some with specialized training in neuropsychology, provide psychological services for stroke patients at the Fanny Allen Campus. They perform initial psychological consultations for Inpatient Rehabilitation patients, and serve as an integral part of the care team, working closely with the patient and family, physical therapists, physicians, rehabilitation nurses, speech-language pathologists, social workers and others. These professionals also provide outpatient services at the request of the patient's physician or outpatient therapist.

Family Support Services

Social workers provide assistance for stroke patients and their families to help them cope with any financial or family issues that arise, and transition to life outside of the hospital. They work closely with the patient, family and care team to identify what services will be needed for the patient upon discharge - such as follow-up home health care, outpatient therapy, Meals on Wheels and Lifeline medical alert systems -- and make referrals to these services.

Palliative Care

Stroke patients, and others with life-threatening or chronic illness, benefit from The UVM Medical Center's Palliative Care program - a comprehensive service for inpatients that helps patients feel better through aggressive symptom and pain management. Palliative Care aims to keep patients as comfortable and active as possible and helps patients at all stages of illness - through treatment and beyond. Palliative care specialists also provide emotional support for patients facing difficult medical decisions

The University of Vermont Medical Center serves all of Vermont and the northern New York region. Located in Burlington, The UVM Medical Center is a regional, academic healthcare center and teaching hospital in alliance with the University of Vermont.